Employment References - Refer to people familiar
with your work performance or academic background.

Name

Phone Number

Address

Company/Position

Number of Years Acquainted

Name

Phone Number

Address

Company/Position

Number of Years Acquainted

Name

Phone Number

Address

Company/Position

Number of Years Acquainted

Name

Phone Number

Address

Company/Position

Number of Years Acquainted

Work Preference

Specific Position/Job Desired

Minimum Wage/Salary Requirements

Location Preference

If currently out of state, Are you relocating to Portland, Oregon?

Yes
No

If currently out of state, Are you willing to relocate to Portland, Oregon?

Yes
No

Date Available to Start

How did you become aware of this opening?

Additional Information

May we contact your present employer for a reference?

Yes
No

If no, why not:

Were you ever discharged or requested to resign a position?

Yes
No

If yes, please explain:

When required by job, are you willing to work overtime and weekends?

Yes
No

If no, why not:

Are you available for full time work?

Yes
No

If no, what hours can you work?

Have you ever been convicted of a felony?

Yes
No

If yes, indicate dates, location, and disposition:

If you would like to attach a resume, do so browsing your hard drive now (.doc, .txt and .rtf files accepted - 1.5 Mb max size)

Applicant's Agreement

Directions: Read this Agreement before your sign this Application. If you have questions about it, ask someone before you sign it.

By signing this Application, I am agreeing to all of the terms of this Agreement.
I am applying for a job at Jiffy Lube® service center or in an office that is owned and/or operated by a Company that is a franchisee of Jiffy Lube International, Inc. I understand that I would be working for that Company, and not for Jiffy Lube International, Inc.

All of the information I have provided in this Application and any resume I have give the Company is true. I haven't left out anything that is important to explain any information I have provided. I authorize the Company to contact the employers and Employment References I have listed in this Application. If I have checked the box that says "no" in response to the question whether the Company may contact my present employer, then the Company may not contact my present employer. I agree that the Company may investigate my background and the answers I have provided in this Application by having a security check done, obtaining credit reports or in some other way. I promise to cooperate in that investigation.

I authorize my Employment References, my former employers and other companies or people who may have information about me that the Company believes would be useful in evaluating my application to give that information to the Company or its representatives. I release my Employment References, my former employers and other companies or people who provide information to the Company from any liability for giving information to the Company or its representatives.

I understand that if the Company finds that any of the information I have provided in this Application is misleading or is not true, then the Company may not hire me. If the Company has already hired me and then finds that any of the information I have provided in this Application is misleading or is not true, then the Company may terminate my employment.

I understand that the Immigration Reform and Control Act of 1986 requires the Company to collect documents that verify that I am eligible to work in the United States. If the Company offers me a job, I promise to give those documents to the Company before I begin to work for the Company.

I understand that the Company may require a physical examination and/or urine or blood screening as a condition of employing me. If I refuse to have a physical examination, then the Company may not hire me. If I have a physical examination, I agree that the Company may have a sample of my urine or blood tested to determine whether alcohol and/or certain drugs are present. The Company may have the results of any such tests reported directly to the Company. If any urine or blood test shows the presence of alcohol and/or certain drugs, then the Company may not hire me.

I understand that if I am hired by the Company, I may have access to training manuals and policy manuals developed by the Company and/or Jiffy Lube International, Inc. I understand that those manuals may include confidential information. I agree not to make copies of any of those manuals or tell anyone who is not employed by the Company any of the information in those manuals.

I agree that any idea I have or develop while I am employed by the Company that relates to the quick oil change business or any business authorized to be conducted at a Jiffy Lube service center and that can be patented, copyrighted or registered as a trademark or service mark belongs to the Company and not to me. I promise to sign any agreements or other documents that the Company many need in order to patent or copyright these ideas or to register them as trademarks or service marks. The Company may, in turn, assign these ideas to Jiffy Lube International, Inc. My salary or wages are adequate payment for these ideas; neither the Company nor Jiffy Lube International, Inc., will have to pay for them even if they collect payments or royalties from other people to whom the ideas are licensed.

If the Company offers me a job, and if I accept, then I promise to comply with the Company's policies that are relevant to my employment. I understand that the Company may change its policies from time to time without giving me any notice before a change is made.

If the Company offers me a job, and if I accept, then I understand that I will be employed "at will." Subject to state and federal laws that restrict the Company's rights to terminate my employment for certain reasons, the Company can terminate my employment at any time and not be liable for anything but the salary or wages I have earned at the time my employment is terminated.